Spillover Effects

The current healthcare climate is making it increasingly difficult for prosthetists and orthotists to fit their patients with devices that provide optimal outcomes. As a result of the Centers for Medicare & Medicaid Services (CMS) Recovery Audit (RA) program, a growing number of Medicare claims for prosthetic devices are being denied, and claims that were previously paid are being reopened and repayment is being demanded. Prosthetics patients have been largely unaffected by these developments. Patients are not asked to return the device in question, and they are not responsible for paying back the claim. The financial burden rests solely on the shoulders of the O&P care provider. There have already been a number of spillover effects. The financial ramifications of the audits are forcing some O&P practices to close their doors. Because of the rate at which prosthetics claims are being denied, "there is a sense that beneficiary access to advanced prosthetic technology is being restricted," writes Peter Thomas, JD, general counsel to the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) in his article " High Public Profile Sets Tone for Public Policy Impacting O&P Consumers ." The situation has proven untenable for the O&P profession. On May 13, the American Orthotic & Prosthetic Association (AOPA) filed a lawsuit on behalf of its members against the U.S. Department of Health and Human Services (HHS)/Medicare, seeking relief from the unfair and unauthorized actions of the CMS, primarily via actions of its Recovery Audit Contractors (RACs) and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) relating to physician documentation requirements (see " AOPA Files Suit Against HHS, CMS " in our news section). Referencing the August 2011 HHS Office of Inspector General (OIG) study "Questionable Billing by Suppliers of Lower Limb Prostheses" and the increased physician documentation requirement for prosthetics claims, "AOPA's lawsuit maintains that the OIG/CMS action has changed the standard of care, often forcing practitioners to choose meeting the patient's immediate need for a prosthesis by providing a less sophisticated device, rather than endure long delays in care triggered by the paper chase with physicians." This issue of The O&P EDGE will be distributed at the Amputee Coalition National Conference in Orlando, Florida. If you are the recipient of high-quality prosthetics care, I urge you to reach out to your congressional representative and let him or her know. Your future standard of care is at stake. Thanks for reading.

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Prosthetist Receives Top Army Honor

Jurisdiction B Releases Prepayment Review Results of O&P High Error Audits

Jurisdiction B Releases Prepayment Review Results of O&P High Error Audits

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